University

06/02/2009

Survey says: Ritalin doesn't work

If the scientific establishment didn’t have ADHD, this is the sort of thing they would be paying attention to:  a long-term study recently completed by the National Institutes of Mental Health (NIMH) showed that there are few-to-no long term benefits for treating children with ADHD with Ritalin.

According to the NIMH report: 

The eight-year follow-up revealed no differences in symptoms or functioning among the youths assigned to the different treatment groups as children. This result suggests that the type or intensity of a one-year treatment for ADHD in childhood does not predict future functioning.

Additionally: 

 

A majority (61.5 percent) of the children who were medicated at the end of the 14-month trial had stopped taking medication by the eight-year follow-up, suggesting that medication treatment may lose appeal with families over time.  The reasons for this decline are under investigation, but they nevertheless signal the need for alternative treatments.

And, perhaps most importantly:

Children who were no longer taking medication at the eight-year follow-up were generally functioning as well as children who were still medicated.

These are the kind of results that humanistic psychologists have been predicting for some time, and humanistic psychology can be excused an exasperated sigh when it reads that the NIMH now thinks that the actual symptoms of individual children might be the most important factor they present with, as noted below:

The researchers also speculate that a child’s initial clinical presentation, including ADHD symptom severity, behavior problems, social skills and family resources, may predict how they will function as teens more so than the type of treatment they received.

 

Kirk Schneider, a member of Saybrook’s psychology faculty, says that in fact this study is hardly an isolated incident.  Instead, he says, it’s “representative of a growing literature about the lack of robust, long-term effectiveness of medical-only and ‘single-solution-focused’ treatments.’  The question of ADHD, like the question of most syndromes of human suffering is bound to be more than a ‘one shoe fits all’ issue.”

Another critical take on the use of clinical medications came at Slate.com, where author Darshak Sanghavi pointed out that clinical drug trials are often only testing for things that are easily measured, rather than the results that actually matter.

“Few drug-trial studies have the time or money to study the actual health outcomes that people care about, such as whether the middle-aged man avoids a heart attack after a few decades, the hyperactive first-grader holds down a good job someday, or the menopausal woman remains free from a hip fracture when she's elderly,” Sanghavi writes.  “Waiting for these events would stifle any meaningful innovation, so doctors pick surrogate endpoints, which they hope serve as short-term checkpoints. Thus drug trials for the preceding examples may just decide to measure the middle-aged man's cholesterol level, the youngster's symptom checklist for hyperactivity, and the woman's bone density with a DEXA scan.”

Unfortunatly, Sanghavi points out, these “surrogate endpoints’” “relation to the actual outcome may be weak or nonexistent.” 

 A better approach to ADHD, Schneider suggests, is to take the “phenomenological factors of the child's subjective and intersubjective worlds into account” to produce a more comprehensive intervention. 

“It may be that cultural factors involving the increased use of television, videos, and passive-receptive ‘distractions’ from real-life encounters with self and others are integral to the development--and hence, amelioration of ADHD,” Schneider suggests.  “And if this is the case, then it is no wonder that medicine--or any quick fix--has a very delimited effect.  What is greatly needed in this field, as in our culture at large, is a reexamination of what it means to be a vital and vulnerable human being.”

  

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Posted at 10:30 AM in

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